Suturing of a textured breast implant filled with cohesive silicone gel to prevent dislocation.

We present a case of unilateral anchoring of a style 410 breast implant filled with cohesive silicone gel (McGhan) with four 3/0 braided polyester (Mersilene) sutures. Reoperation after one week and magnetic resonance scanning after six months showed no leakage or bleeding of the prosthesis. Fixation is possible because of the development of cohesive silicone gel in breast implants. Follow up of this patient is necessary for evaluation of long term results.     

Locoregional silicone spread after high cohesive gel silicone implant rupture.

A 45-year-old patient had routine cosmetic bilateral breast augmentation 6 years previously using cohesive gel implants. She presented 4 years later with a breast lump and multiple axillary lymph nodes. Exploration revealed that the breast implant had a large tear at the posterior wall of the shell with intra-capsular leakage of silicone. The axilla had eight enlarged lymph node--all were removed. Histology showed silicone granuloma in the capsule and silicone lymphadenitis. High cohesive gel implants may not be as safe as is commonly believed and all implant ruptures, irrespective of the cohesiveness of the silicone gel, should be investigated thoroughly.     

Management of Tuberous Breast Deformity with Anatomic Cohesive Silicone Gel Breast Implants

Background  Tuberous breast deformity is a rare congenital condition that often requires surgical correction. Numerous surgical techniques have been described, reflecting the reconstructive challenge of this deformity. The anatomic cohesive gel breast implant is a powerful tool in both aesthetic and reconstructive breast surgery. In the authors’ experience, its use in treating tuberous breast deformity has provided the opportunity for a single-stage approach, with very good results. Methods  The senior author has managed more than 50 cases of single-stage reconstruction for tuberous breast deformity using anatomic cohesive gel breast implants. His surgical technique is described with suggestions for achieving optimal results. Representative case examples are provided. Conclusions  The anatomic cohesive silicone gel breast implant is an excellent device for treating tuberous breast deformity. It often can be used as a single-stage correction of the deformity with very good results. The authors strongly advocate consideration of its use in tuberous breast deformity reconstruction.     

Breast Implant Stability in the Subfascial Plane and the New Shaped Silicone Gel Breast Implants

The author presents his experience with breast augmentation using a next-generation, form-stable, anatomically shaped silicone gel breast implant. Rotation is a potential complication for anatomically shaped breast implants. Anatomically shaped saline implants have been reported to have a rotation rate as high as 14%, while lower rotation rates of 1–2.6% for anatomic cohesive gel silicone implants have been reported. Currently, these implants are limited in the United States to US FDA-approved clinical trials. The author reviews the appropriate surgical techniques to prevent rotation when using these devices. A recent innovation, placement of the superior pole of the implant underneath the superficial fascia of the pectoralis major muscle, is described. Primary and secondary breast augmentations in 241 procedures using the Allergan Style 410 implant resulted in a 0.0% rotation rate. Overall, the anatomic form-stable silicone gel breast implants, when placed subfascially, improve common complications such as capsular contracture and implant rupture with improved aesthetic outcomes and patient satisfaction.     

Implications of Transaxillary Breast Augmentation: Lifetime Probability of Breast Cancer Development and Sentinel Node Mapping Interference

After the “fifth-generation” breast implants with ultracohesive silicone gel technology are introduced, the Food and Drug Administration (FDA) will sooner or later retire the ban on the use of these devices in the United States. When this happens, the plastic surgery community must be prepared to face a massive demand for reoperations to change saline-filled breast implants because cohesive gel devices have the potential to provide a more natural breast shape, to minimize the risk of postoperative rippling, and to provide a greater degree of safety if the implant loses its integrity. Despite these advantages and extensive use throughout the rest of the world during the ban in the United States, silicone implants also have disadvantages. One drawback is that transaxillary breast augmentation with more “rigid” gel-filled implants may produce trauma to the armpit, may interfere with sentinel node mapping for breast cancer treatment, and may have future medicolegal implications.     

Breast augmentation with anatomical cohesive gel implants: the world's largest current experience

Anatomic cohesive silicone gel implants in breast augmentations require a considerably different technique compared with standard round implants. If the dimensions and proportions of the thorax and breast and thus the prerequisite for different implant shapes are evaluated adequately, this newer technique can lead to highly predictable results with a high degree of patient satisfaction.     

A silicone implant filled with cohesive gel: advantages and disadvantages

This article presents our experience with an anatomically-shaped implant, which is filled with a special cohesive silicone gel. From 1993 through 1996, 132 women underwent breast augmentation. The indications were simple aplasia/hypoplasia (40), unsatisfatory appearance of previous prosthesis (58), and post-mastectomy deformity of the breast (34). Results and complications are reviewed. The findings suggest that this type of implant is safe and achieves satisfactory results in breast augmentation. Received: 7 February 1997 / Accepted: 20 April 1998     

Early experience with an anatomical soft cohesive silicone gel prosthesis in cosmetic and reconstructive breast implant surgery

Recently, an anatomic breast implant filled with soft cohesive silicone gel was introduced by Mentor Medical Systems onto the European market. This study reports the early experience of a single surgeon with this implant. All patients who received a Contour Profile Gel (CPG) implant from March 2001 to October 2002 were studied. Patient satisfaction with breast shape and consistency was assessed using linear analogue scales with a maximum score of 10. Thirty-five patients received CPG implants for cosmetic (10 patients, 20 breasts) and reconstructive (25 patients, 31 breasts) surgery purposes. Patients were satisfied with their breast shape (mean score: 8.3). Eighty-five percent of the breasts were rated as soft (score >/=6). No serious esthetic complications such as implant malposition or significant capsular contracture were observed. Anatomic soft cohesive gel implants provide excellent results in selected cases. They are well accepted by patients and not associated with an increased rate of complications.     

硅胶注射隆乳术后出现乳腺癌病理分析

目的　探讨硅胶注射隆乳术后出现乳腺癌的相关性分析。方法　对 4例硅胶注射隆乳术后出现乳腺癌的患者进行临床病理分析。结果　 4例女性患者行硅胶注射隆乳术 ,半年～ 2年后出现乳房肿块 ,直径在 5cm以上 ,临床误诊为注射硅胶的炎症反应。光镜病理检查 :在癌细胞巢之间可见一些黏液样淡蓝色均匀一致的硅胶。局部淋巴结均可见癌转移。结论　硅胶可能是尚待证实的诱发或促进乳腺癌发生的原因之一 ,硅胶注射隆乳并发乳腺癌容易误诊 ,确诊依靠组织活检。硅胶注射隆乳术应明令禁止。     

Anatomic breast implants in aesthetic and reconstructive surgery: report of 135 cases

The aim of this work is to precise the indications to respect and the pitfalls to avoid in prosthesis setting using anatomical cohesive silicone gel implants.135 patients that undergone a reconstructive or cosmetic prosthesis setting were reviewed. Patients satisfaction has been assessed basing on the breast shape, consistency and symmetry. Complications (both usual and specific) were assessed and analysed. The results for mammary reconstruction after expansion or autologous flap and for cosmetic submuscular breast augmentation were good. Complications were unusual as far as the appropriate surgical procedure had been performed rigorously. These implants are an interesting alternative solution to round shape prosthesis in reconstruction indication. In breast augmentation border line indications, a beautiful result may be expected using these implants.     

Anatomically Shaped Breast Prosthesis <Emphasis Type="Italic">in Vivo</Emphasis>: A Change of Dimension?

Background In addition to the already existing round cohesive gel-filled breast prostheses, anatomically shaped breast prostheses were introduced in 1990 to provide a more natural shape to the augmented or reconstructed breast. To date, however, it is unclear whether the anatomic configuration of the prostheses is maintained after subpectoral implantation. Recently, a three-dimensional (3D) magnetic resonance imaging (MRI) technique became available, offering a precise visualization of the prosthesis in vivo. Using this 3D MRI technique, this study aimed to compare the shape of commercially available round and anatomically shaped silicone gel-filled breast prostheses before and after implantation. Methods Using 3D MRI, 6 conventionally round and 12 symmetrically shaped silicone gel-filled prostheses were scanned in vitro. Scans were made in vivo 6 weeks after subpectoral implantation of these prostheses in nine patients. The in vivo 3D images were compared with the in vitro 3D images. Results Overall, a 3.5% decrease in projection was found on the in vivo images, as compared with the in vitro images. On the craniocaudally oriented images, a slight lateral shift of the cohesive gel was observed in the majority of the prostheses. Inamed Style 510 prostheses showed the best in vivo preservation of their configuration. Conclusions The results show that both the round and the anatomically shaped silicone prostheses in vivo largely maintain their original in vitro configuration after subpectoral implantation. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Residual silicone detection using mri following previous breast implant removal: Case reports

The current controversy surrounding the safety of silicone gel breast implants has resulted in an increasing number being removed. Although previous reports have suggested that remnants of the implant capsule are reabsorbed after explantation surgery, the persistence of the capsule in fact may be associated with implant fragments and silicone gel leakage. In this study we have used magnetic resonance imaging (MRI) to identify residual silicone gel and silicone granulomas following the removal of silicone gel breast implants. Four representative clinical case reports are presented. These patients, who had residual silicone present in their bodies, presented to us with breast pain, palpable masses, or abnormal calcific mass densities apparent on a mammogram. High-resolution MRI images were found to be helpful in identifying local and remote collections of silicone gel, silicone granulomas, and residual capsules that were incompletely removed from previous explantation surgery. MRI breast images demonstrated high resolution and provided the accurate anatomical locations of residual silicone gel and silicone granulomas in all the regions of breast parenchyma, chest wall muscles, and axillae. Patients with persistent local symptoms following explantation surgery may benefit from an evaluation of the breast using MRI.     

Changes over Time in Mammary Compliance Values After Breast Augmentation

Capsular contracture is the most troublesome and distressing complication after breast augmentation for both the surgeon and patient. The etiology of capsular contracture remains unclear. Clinical treatment for this complication is based on the surgeon’s evaluation, the condition of the breast, and a number of other factors. In a previous study, the authors investigated whether measurement of mammary compliance as a means of assessing capsular contracture was comparable with other methods described for the assessment of capsular contracture. The purpose of this study was to evaluate whether capsular contracture varies significantly over time. A prospective study was performed to measure mammary compliance in 60 female patients who received a total of 120 implants between 2000 and 2002. The implants used were anatomic prostheses filled with cohesive silicone gel and round double-lumen prostheses filled with silicone gel and saline solution. All the patients were followed up for at least 2 years. Statistical analysis of the data also was performed to assess significance. The results showed a general trend in mammary compliance values over time.     

Prosthetic mammoplasty sensitivity syndrome: a case for causation

Treatment of patients experiencing adverse health effects following prosthetic mammoplasty has suffered from a lack of an acknowledgment of a causal relationship to their breast prosthetic devices. Case reports and case series showing an association between adverse health effects and breast implants have been routinely dismissed as anecdotal, and epidemiological studies have been considered necessary to prove causality. We show that epidemiological research is not necessary for establishing a causal relationship, and one properly documented case can be, in fact, all that is needed to show causation. Presently in the peer-reviewed literature there exists a substantial scientifically sound body of data showing an association between breast implants and adverse health effects. Ample evidence has shown that exposure to the five common types of breast implants outlined, i.e., silicone gel filled, saline filled, double lumen, polyurethane coated, and cohesive silicone, has caused adverse health effects in humans. Prosthetic mammoplasty sensitivity syndrome (PMSS) is the proposed term to describe the disease processes documented in the literature that has a causal relationship to breast implants.     

Late migration of silicon as a complication to breast transplant rupture: Case report and literature review

Silicone implants have been used for breast augmentations, both cosmetically and in reconstructive surgery since the 1960s. Rupture of breast implants and silicone migration is a well-known complication. In this case report and literature review, we present a case of a 53-year-old woman with bilateral cosmetic silicone gel breast implant in 1986, and a replacement with saline gel in 2005. The patient had no breast complaints and observed no change in breast volume during this period. In 2020, silicone was randomly identified in a right-sided cervical lymph node in an attempt to remove suspicious lymphadenopathy. The source of the silicone is still doubted; that is, it is not known if the silicone originated from the saline implant or the silicone gel implant.In our literature review, we find that distant migration of silicone and lymphadenopathy have occurred for silicone breast implants although very rare for saline gel breast implants.     

Silicone gel breast implant rupture presenting as a fluctuant back mass after latissimus dorsi breast reconstruction

The authors describe a patient who presented with acute onset of a lower back fluctuant mass 12 years after breast reconstruction with a latissimus dorsi musculocutaneous flap and silicone gel implant. Aspiration and subsequent surgical exploration revealed this mass to be free-flowing silicone gel within a cavity that was confluent with the breast implant capsule through an axillary tunnel. Excision of the back cavity, explantation with subtotal capsulectomy, and implant replacement resolved the problem. Although distant migration of extracapsular silicone gel from the breast to the axilla, arm, abdomen, and groin has been described, the authors think this represents the first reported case of distant migration of silicone gel to the lower back.     

Rupture of an expander prosthesis mimics axillary cancer recurrence.

Regional silicone gel migration from a ruptured breast implant has been reported at different locations including the upper extremity, chest wall muscles, axilla and back. We report a patient who presented with an axillary mass that mimicked a regional recurrence 5 years after breast cancer reconstruction with a latissimus dorsi musculocutaneous flap and silicon gel expander-prosthesis. Surgical exploration revealed that the mass contained silicone gel around the port of the breast expander that had ruptured. The mass was confluent with an intracapsular silicone leak through a tract along the tube of the expander port.     

胸大肌包裹假体置入一期乳房重建在保留皮肤的乳癌根治术中的应用

目的：探讨保留皮肤的乳腺癌改良根治术一期胸大肌包裹假体置入乳房重建的可行性。方法：对28例0、I、II期乳腺癌患者行保留皮肤的乳腺癌改良根治术后,同期于胸大肌后方置入硅胶假体重建乳房,并根据冰冻切片检查结果决定是否保留乳头乳晕复合体。结果：28例早期乳腺癌患者均保留了乳头乳晕复合体,术后随访2～18个月,外观良好,双侧乳房对称,优良率达96.5%。所有病例均无局部复发或远处转移,无明显术后并发症。结论：保留皮肤的乳腺癌改良根治术后用硅胶假体行一期乳房重建,能达到满意的乳房美容效果,是治疗早期乳腺癌安全可行的方法。     

Morphology of breast implant fold flaw failure

The percent of modern silicone gel breast implants that fail due to shell rupture is quite low, amounting to less than 1% per year. Nonetheless, extensive retrieval and analysis studies are being conducted on failed devices returned to Allergan Medical (formerly Inamed Corporation) in order to determine the modes and causes of failure. With the modes and causes known, solutions can be implemented to eliminate the failure mechanisms. Analyses conducted thus far have demonstrated that there are several causes of breast implant failure. The focus of this paper is on one type of silicone gel breast implant failure, i.e., a failure associated with a fold or wrinkle, which is termed "fold flaw failure." Although fold flaw failure is not a dominant mode of failure for silicone gel breast implants, its failure characteristics must be understood in order for this type of shell rupture to be detected and eventually eliminated. In this study, optical microscopy and scanning electron microscopy are used to describe the morphology of fold flaw failure for explanted silicone gel breast implants with smooth shells. The microscopy analysis demonstrates that there are several different types of shell failure patterns that can be produced by a fold or wrinkle in a silicone gel breast implant.     

乳晕切口法解剖型假体隆乳术治疗轻度乳房下垂

目的探讨应用解剖型假体(又称泪滴型假体)隆乳术矫正轻度乳房下垂的可行性及临床效果。方法术前依据原乳房三维形态,测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据,以确定所需采用的假体类型、容量及下垂乳房下皱襞距离,选用乳晕切口对36例轻度乳房下垂者应用麦格410解剖型假体行隆乳术。结果全部隆乳者术后乳房挺拔,下垂基本得到矫正,受术者均表满意。结论应用解剖型假体的隆乳术是目前矫正有增大乳房容积愿望的轻度乳房下垂者的最佳选择之一。